Annual screening mammography in women beginning at 40 years of age has been clearly shown through reliable research to reduce the death rate from breast cancer in the population by 30-40%. As time passes the research predicts that even more lives will be saved. Other imaging tests, such as breast ultrasound and breast MRI, have been shown to help find smaller and earlier stage breast cancer and are used in special circumstances. However, mammography is the gold standard for screening for breast cancer, and is the only test proven by multiple large clinical research trials to reduce mortality in large populations of women. Also, there is at least one sign of early breast cancer, abnormal calcifications, which is only detectable by mammography.
The purpose of screening mammography is to find breast cancer at a very early stage before it becomes noticeable any other way. A screening mammogram is recommended once every year for all women 40 years of age or older who are healthy, not pregnant, and not experiencing any breast-related problems. It is a simple X-ray examination of the breasts consisting of 2 or 3 images of each breast taken by a certified technologist. It is a quick in-and-out appointment lasting between 15-30 minutes from check-in to check- out. Patients receive results by mail within 2 weeks. The patient’s primary physician also receives a report. If the mammogram shows something that requires diagnostic mammogram views or ultrasound our nurse will promptly call the patient to return for the supplemental evaluation. The majority of screening mammograms are normal, but about 8% of patients will be recalled for supplemental diagnostic imaging. Most of the patients recalled for diagnostic imaging will also end up being normal, but about 20% of those recalled may require follow-up imaging in 6 months or a needle biopsy.
Screening Automated Whole Breast Ultrasound (AWBUS)
The purpose of screening automated whole breast ultrasound (AWBUS) is to help detect small early stage breast cancer in women whose breast tissue appears dense on their mammogram. AWBUS should always be done in conjunction with a screening mammogram. It does not replace the mammogram. The radiologist reports the tissue density on the mammogram report, and patients are informed in person at the time of their mammogram and by mail with their mammogram results if their tissue is dense on the mammogram. If the report states that the tissue is “heterogeneously dense (density category C)” or “extremely dense tissue (density category D)” then the patient is offered AWBUS because dense tissue may hide small cancer tumors on the mammogram that may be seen by ultrasound. The AWBUS is done during the same appointment with the mammogram and takes an extra 15-30 minutes. AWBUS is performed by a certified technologist who scans both breasts entirely. The technology allows the entire scan to be recorded in a 3-D volume so that the radiologist can replay and review the entire scan using specialized software in 3-D. Sometimes the technologist will perform a hand-held conventional 2-D ultrasound evaluation to screen the breast or supplement the AWBUS. The screening mammogram and AWBUS are evaluated and reported together by the radiologist. Patients receive results of the screening mammogram and AWBUS together within 2 weeks. Like screening mammography alone, most of these combined screening evaluations are normal, but about 5% will be recalled for supplemental diagnostic mammogram views or targeted ultrasound evaluation. About 20% of those recalled will require a 6 month follow-up examination or a needle biopsy.
Screening Breast MRI
Breast MRI is recommended as a supplemental screening test for women who are at very high risk of developing breast cancer because of a genetic or hereditary risk of breast cancer. Annual screening breast MRI should always be done in combination with an annual screening mammogram. It does not replace the mammogram. These women at high risk typically have multiple close family members who have had breast cancer or ovarian cancer. Also, there is a blood test that can identify women and men who carry an abnormal gene, or hereditary trait, which makes them at very high risk of developing breast cancer. For these women, yearly screening with mammography and breast MRI may start at an earlier age, usually at 25 years of age. Also, annual screening breast MRI is recommended for women who were treated at an early age for Hodgkin’s lymphoma with radiation to the chest.
Bone density is a fast, simple screening procedure to determine the density of your bone tissue. The measurements from the procedure are compared to those of a reference population based on relevant information such as age, weight, sex and ethnic background. This information is used in making a diagnosis about your bone status and fracture risk. This information will be helpful to your physician in determining if a bone building therapy is needed.